Hepatitis B surface antigen monitoring and management of chronic hepatitis B

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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2011.01465.x/abstract

REVIEW

Hepatitis B surface antigen monitoring and management of chronic hepatitis B

M. J. Sonneveld, R. Zoutendijk, H. L. A. JanssenArticle first published online:

23 MAY 2011

DOI: 10.1111/j.1365-2893.2011.01465.x

© 2011 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Early View (Online Version of Record published before inclusion in an issue)

Summary.  Serum hepatitis B surface antigen (HBsAg) levels reflect

intrahepatic hepatitis B virus (HBV) covalently closed circular DNA and may be a

valuable addition to HBV DNA in the management of patients with chronic

hepatitis B (CHB). Among HBeAg-negative CHB patients with low HBV DNA levels,

HBsAg quantification may help distinguish those with active CHB from true

inactive carriers with a very favourable prognosis, thus limiting the need for

long-term intensive monitoring of ALT and HBV DNA levels. In patients treated

with peginterferon (PEG-IFN), achievement of a decline in HBsAg during therapy

appears to be an important marker for treatment outcome, and several groups have

proposed stopping rules based on HBsAg thresholds. A recently described stopping

rule incorporating a combination of HBsAg and HBV DNA levels can accurately

identify HBeAg-negative patients, especially those with HBV genotype D, not

responding to PEG-IFN. Current applications of HBsAg levels in the monitoring of

patients treated with nucleo(s)tide analogues are still being evaluated. First

data from these studies show that HBsAg decline, and thus subsequent clearance,

is confined to those with an active immune response to HBV, such as

HBeAg-positive patients with elevated ALT, or those who achieve HBeAg clearance.